Professionalism

The Practice of Medicine requires a specialized body of knowledge and skills, and physicians have a responsibility to their profession and a duty to their patients. Washington University School of Medicine is committed to the professional delivery of medical care, and has a structured and integrated curriculum. Professionalism also has a formal evaluation process to recognize outstanding examples in addition to those necessitating further reflection and remediation.

The Neurology Clerkship fully subscribes to all the tenets of professionalism, and seeks to educate through didactics and example. Professionalism encompasses attitudes and behaviors which are a substantial and integral part of the feedback and evaluation process. In 2004, a WUSM Professionalism Working Group included clinical and basic science faculty, in addition to students from all years. They examined a list of qualities defining professionalism, and constructed guiding principles of how these qualities translate into our expectations for all WUSM students.

Honesty and Integrity

Self-Regulation and Accountability for Self and Colleagues

Adherence to High Moral and Ethical Standards

Compassion and Empathy

Cultural Sensitivity

Respect

Subordination of One’s Own Interests

Altruism

Receiving and Responding to Criticism

Evidencing Professional Competence

Teamwork

Response to Societal Needs

Policy Regarding Professionalism Concern Forms

The third year of medicine can be stressful. As you are immersed in busy medical settings, you are working with many people, encountering new situations, grappling with your role as care provider, have new demands placed on time which can result in fatigue, and your future medical career seems to be under constant evaluation. While students are selected for admittance to the WUSM based upon achievements and indicators of professionalism, professionalism must also be taught and modeled.

For many professionalism concerns, you should receive feedback so you can make the appropriate adjustments and demonstrate that the advice has been well-heeded. If this feedback is not followed, or if additional examples become apparent, we must submit the Professionalism Concern Form to the Office of Student Affairs. For professionalism concerns relating to integrity, honesty, and respect, a Professionalism Concern Form will always be submitted on the first occurrence.

Professionalism Guiding Principles

The Student, their peers and the classroom:

While individual effort is important in their development of a medical knowledge base, much of what students learn in medical school will depend on a collaborative effort with their peers.

During the clinical years, students should understand that their peers are a valuable resource as they learn to take care of patients. Likewise, a student should assist peers in patient care responsibilities.

In all cases, students should respect the work and learning opportunities of their classmates and they should be mindful to avoid taking away the educational opportunities from their peers. Competitive behaviors such as taking over patient responsibilities of others, interrupting other’s presentations, aggressively seizing others’ opportunities to present, ask/answer questions, admit patients, participate in surgical cases/procedures, or perform duties are unprofessional and should be avoided.

Preparation for class and during clinical rotations sets a good example for peers and avoids disruption of others.

Setting a good example for one’s classmates is achieved by being prepared. Students should not discourage others from preparing in advance.

Disturbing one’s peers in a classroom or in the hospital setting includes behaviors such as: being late to that session, propping one’s feet up on a table or chairs or other distracting gestures, talking (to someone not leading the main discussion) at an unreasonable volume, making/receiving phone calls, sleeping.

Student work should be original.

Only authorized resources should be used during examinations, quizzes or graded course work.

When students are aware that one of their classmates has submitted work that is not their own (cheated), they should discuss this situation with the Course Master and/or the Associate Dean of Student Affairs.

If a student observes cheating on homework assignments or during exams, that student should discuss the matter with the Course Master.

Respect for the ethnic and cultural diversity of classmates provides for a more nurturing environment for all. Avoid derogatory comments about the culture and identity-including gender, religion, ethnicity (nationality), and sexual orientation of classmates.

Students should be aware that their classmates come from a wide variety of religious and ethnic backgrounds and they will have differing lifestyles and viewpoints.

In order to function at the expected level, students should attend to their own physical and emotional health. Students should likewise assist peers in resolving interpersonal conflicts.

Students need to be able to identify when they are overwhelmed to the point where they may not be able to function at a level that is expected by the faculty. The students are encouraged to seek out educational assistance and/or the emotional support of others in these instances.

Students must appreciate that their peers may have issues in their personal or professional lives (e.g. family, medical, academic, or administrative problems) that may affect their interactions with others. In these circumstances, students should make every attempt to be sympathetic and to offer their support, if desired, to those students.

The Student and their faculty/residents/fellows:

Participation and teamwork on clinical rotations enhances the educational experience.

The learning process is a partnership between students and faculty. Students should actively participate in this partnership by providing feedback to professors by way of post-lecture evaluations and participation in course evaluations.

In the clinical setting, students should assist whenever necessary in the context of the learning environment.

Reflecting on one’s strengths and weaknesses and admitting mistakes to others on the team is a natural point of the physician learning process.

The idea of infallibility is dangerous in all aspects of existence, and most particularly in the practice of medicine. Students should view mistakes as part of learning; assuming responsibility for mistakes is important. Developing productive strategies for dealing with mistakes and non-confrontational ways of correcting them is essential. Credibility comes with the admission of errors and the desire to correct them.

Understanding the appropriate venues for feedback to faculty/house staff/fellows is critical to successfully resolving conflicts.

Students should be aware of the appropriate mechanisms for handling disagreement with faculty/residents/fellows, and know the chain of command for handling disputes. Conflicts can be translated into productive outcomes if handled appropriately.

Students should not act reflexively, but should consider the possibility/likelihood that they have a limited view of the medical arena, and that opinions of their faculty/residents/fellows that may initially seem opaque are often actually founded on good bases.

Students should attempt to provide suggestions and examples for improving the mentoring environment.

Concerted attention to the advice and criticism faculty/residents/fellows should be taken in the context of mentoring.

Maintaining a professional relationship with faculty/residents/fellows is important, especially during the time when the faculty/residents/fellows have evaluating/grading power over the students.

During the period of a clinical rotation, students should avoid behaviors that could potentially be construed as “bribing”, i.e., any activities that could provide personal gains to the faculty/residents/fellows in a non-academic context.

The University has specific codes and regulations regarding romantic relationships between a student and a faculty/resident/fellow (faculty or resident). Students engaged in such relationships should review these codes and avoid any situation that can cause potential conflict of interest in the academic setting.

The student and their patients:

Patients should be treated as individuals within their families and their cultural and social communities. Recognizing personal biases and working hard to subordinate them in these interactions will improve the overall relationship.

Religious, political, racial biases should not be introduced into clinical decision making. The student should remember to keep the patients’ view point and interest primary.

No use of offensive language or gestures is acceptable in dealing with patients.

Students should also be aware that some religious groups do not allow their members to receive certain medical interventions, and therefore alternative care approaches must frequently be considered.

Students should not refuse to participate in the care of a patient because of a perceived threat to the student for a reason that would not be agreed upon by the care team. For example, a student who is verbally or physically threatened by a patient may ask to be dismissed from care, but a student may not ask to be removed from the care of an HIV positive patient simply due to the patient’s HIV status.

Students should be alert to patients’ rights and maintain the confidentiality of information.

Patient information should only be discussed with appropriate people at appropriate times.

Patient records should not be photocopied carelessly or removed from appropriate areas.

Patient information should be disposed of appropriately to prevent careless transmission of patient information.

Clear communication of personal abilities and training level to patients and families is critical.

If a student does not know the answer to a patient’s question, it is his/her responsibility to admit this lack of knowledge.

Even if other members of the health care team introduce students to patients as “doctor,” the student should never do so as it leads to a false perception of expertise on the patient’s part.

Students should always be truthful with the house staff and other medical staff in terms of patient care and never compromise patient care as a consequence of personal gain.

Students have a professional responsibility to actively participate in their education and to work to improve the educational environment for future students. A willingness to pursue life-long, self-directed learning is an essential attribute of any professional.

No student should participate in any aspect of patient care if under the influence of a substance that may compromise his/her judgment or otherwise cause the patient harm. Likewise, students should report any member of the health care team who may be participating in patient care while under the influence of a judgment-impairing substance.

Any student who is physically or emotionally ill should consider the impact on patients of his/her illness and excuse himself/herself from patient care if deemed necessary by the patient’s or a colleague’s judgment. Likewise, students should be aware of such illnesses in their colleagues and take action to call attention to it.

If an error is made in the care of a patient, the student should identify the error and correct it as soon as possible or bring it to the attention of those who can correct it.

Students should be an active participant in the patient’s care and act as an advocate for the patient. If a student feels that a patient’s best interests are not being considered, he should make these thoughts known to the team.

Hospital staff should be treated with appreciation and respect, as they are integral to proper care of the patient. Problems within the health care team can adversely affect patient care.

Students should be constantly aware that patients are ill, and have a right to refuse care, especially when poorly provided.

Although students are often tired or under stress, they should attempt to maintain an appropriate level of composure at all times.

Students should appear neat at all times and dress appropriately for the situation.